| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
No
|
|
|
|
|
|
|
Alaska
|
|
Yes
|
|
|
|
Fee for service at 85% of physician fee
|
CN
|
|
Arizona
|
|
Yes
|
|
Yes
|
Outpatient services limited to ALTCS members - see state-specific FN
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
No
|
|
|
|
|
|
|
California
|
|
Yes
|
$1/visit
|
|
Physician order required, 2 speech pathology visits/month included in limits with other specified practitioners in any setting
|
Fee for service
|
CN & MN
|
|
Colorado
|
|
Yes
|
|
|
Diagnostic audiology procedures limited to specified conditions
|
Fee for service
|
CN
|
|
Connecticut
|
|
No
|
|
|
|
|
|
|
Delaware
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
District of Columbia
|
|
No
|
|
|
|
|
|
|
Florida
|
|
Yes
|
|
|
Limited to services for provision of augmentative and assistive communication systems
|
Fee for service
|
CN & MN
|
|
Georgia
|
|
No
|
|
|
|
|
|
|
Hawaii
|
|
Yes
|
|
Yes
|
|
Fee for service
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
1 audiological testing and evaluation/year, 40 sessions speech therapy/year
|
Fee for service
|
CN
|
|
Illinois
|
|
Yes
|
|
Services other than to continue therapy provided in previous 30 days on inpatient basis
|
Physician order required for specified services
|
Fee for service or certified cost
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
Specified services including therapy not following hospital discharge
|
1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge
|
Fee for service
|
CN
|
|
Iowa
|
|
Yes
|
$2/day
|
|
Limited to audiological assessment for a hearing aid
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
Yes
|
$3/date of service
|
|
Limited to speech pathology for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation
|
Fee for service
|
CN & MN
|
|
Kentucky
|
|
Yes
|
A - $1/visit
|
Yes
|
A - 10 visits/year, C & D - 30 visits/year; audiometric services not covered for adults
|
Fee for service
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
Yes
|
Physician referral required for specified services
|
Fee for service
|
CN & MN
|
|
Maine
|
|
Yes
|
$.50-$2/day for speech pathology services, depending on payment, up to $20/month
|
|
Decline in oral communication or ability to chew or swallow must be demonstrated, rehabilitation potential required
|
Fee for service
|
CN & MN
|
|
Maryland
|
|
No
|
|
|
|
|
|
|
Massachusetts
|
|
Yes
|
|
|
35 speech pathology visits/year
|
Fee for service
|
CN & MN
|
|
Michigan
|
|
No
|
|
|
|
|
|
|
Minnesota
|
|
Yes
|
null
|
After initial 80 sessions
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Mississippi
|
|
No
|
|
|
|
|
|
|
Missouri
|
|
Yes
|
|
|
Adult coverage limited to those who are pregnant, blind or residing in nursing facilities
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
$3/speech pathology visit, $2/visit audiology service
|
|
A - 70 speech pathology visits/year, 30 additional possible with prior approval, audiology services limited to evaluation necessary for provision of hearing aid, B - limited to audiological evaluation necessary for provision of a hearing aid essential for employment
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
$2 or $3/specified services - see state-specific FN
|
|
60 visits/year in combination with other therapies, rehab potential required
|
Fee for service
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
Yes
|
Rehab potential required, audiological testing and evaluation requires physician order
|
Fee for service
|
CN
|
|
New Hampshire
|
|
Yes
|
|
|
Eighty 15-minute time units/year included in limits with other therapy providers
|
Fee for service
|
CN & MN
|
|
New Jersey
|
|
No
|
|
|
|
|
|
|
New Mexico
|
|
Yes
|
A - $5/visit, B - $7/visit - see state-specific FN
|
Yes
|
Audiological testing and evaluation require physician order
|
Fee for service
|
CN
|
|
New York
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
North Carolina
|
|
No
|
|
|
|
|
|
|
North Dakota
|
|
Yes
|
$1/speech pathology visit, $2/audiological evaluation
|
|
1 speech evaluation/year, 30 speech therapy visits/year
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
Specified services
|
30 dates of service/year in non-institutional setting
|
Fee for service
|
CN
|
|
Oklahoma
|
|
No
|
|
|
|
|
|
|
Oregon
|
|
Yes
|
A - $3/visit
|
Yes
|
|
Fee for service
|
A - See state-specific FN
|
|
Pennsylvania
|
|
No
|
|
|
|
|
|
|
Rhode Island
|
|
No
|
|
|
|
|
|
|
South Carolina
|
|
No
|
|
|
|
|
|
|
South Dakota
|
|
Yes
|
|
|
|
Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures
|
CN
|
|
Tennessee
|
|
Yes
|
|
|
|
|
A & B - See state-specific FN
|
|
Texas
|
|
No
|
|
|
|
|
|
|
Utah
|
|
Yes
|
|
A - Yes
|
B - speech pathology limited to treatment following trauma or due to congenital defect, C - speech pathology not covered, 1 audiological evaluation for hearing aid/year
|
Fee for service
|
A, B & C - See state-specific FN
|
|
Vermont
|
|
No
|
|
|
|
|
|
|
Virginia
|
|
Yes
|
$1/visit
|
|
Limited to audiology services
|
Fee for service
|
CN & MN
|
|
Washington
|
|
Yes
|
|
Yes
|
12 visits/year
|
Fee for service
|
CN
|
|
West Virginia
|
|
Yes
|
|
Yes
|
A - 20 visits/year in combination with other therapies
|
Fee for service
|
A & B
|
|
Wisconsin
|
|
Yes
|
$1/audiological testing service; $.50-$3/speech pathology service, depending on payment, up to 30 hours or $1,500/year
|
Yes
|
|
Fee for service
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
|
Speech pathology for post-trauma/illness only, rehab potential required
|
Fee for service
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
Yes
|
|
|
Audiology services limited to evaluation necessary for provision of hearing aid
|
Fee for service
|
CN
|
|
Northern Mariana Islands
|
|
Yes
|
|
Yes
|
|
|
CN & MN - See territory-specific FN
|
|
Puerto Rico
|
|
Yes
|
|
|
|
Fee for service for contracted staff
|
CN & MN
|
|
Virgin Islands
|
|
No
|
|
|
|
|
|
